Introduction

It is currently estimated that by 2050 the proportion of people aged 65+ years worldwide will have more than doubled.1 Considering that age is a major risk for dementia,2 the number of people affected by dementia is, at the same time, expected to increase to 131.5 million by 2050.3 Previous reviews have concluded that pharmacological treatment to prevent or delay cognitive impairment4 or to manage dementia,5 is unpromising. There is recent evidence suggesting that combined therapy (eg, oral citicoline plus memantine) compared with one single treatment (eg, memantine) can slow disease progression in persons with Alzheimer’s disease and mixed dementia.6 These results are very promising from a medical and clinical point of view. From a prevention and thus public health perspective, however, knowledge on the effects of cognitive health promotion, especially among older adults, would be important but is relatively scarce.

The term ‘cognitive health’ is relatively new. People are less familiar with it and there is a need to cover the definition and scope of this term. Cognitive health has been defined as ‘the ability to clearly think, learn and remember’.7 The promotion of cognitive health can be considered as enabling people to ‘increase control over their own [cognitive] health […] [through] a wide range of social and environmental interventions’.8

Potentially modifiable risk factors for cognitive impairment have been described in the literature.9 They include alcohol consumption, depression, diabetes, hypertension, obesity, smoking and social isolation. One way of targeting these risk factors is through health promotion interventions.8 There is growing consensus worldwide that maintaining and promoting cognitive health has become essential for healthy ageing.10

Recent recommendations11 encourage the use of non-pharmacological interventions and prioritise the implementation of longitudinal studies when evaluating cognitive rehabilitation and/or cognitive stimulation therapy. They also call on community-based cognitive interventions provided by caregivers. This requires both training caregivers and making older people and their families aware of the importance to participate in these interventions.12

The ACTIVE study13 was the first large-scale, multisite randomised controlled trial to compare the long-term effects of three cognitive training interventions for maintaining independence in older adults. The results suggested that cognitive training is a protective factor, thus reducing the prevalence of dementia. Subsequently, further initiatives were introduced for the promotion of cognitive health. Pilot studies have tested the implementation of programmes enabling healthy seniors to learn a new language,14 or a dual-tasking tool enabling older adults (with or without mild cognitive impairment) to train their cognitive and physical functions at the same time.15 A web-based tool was developed for educating older people on the promotion of cognitive health and helping them improve their health-related behaviors.16 A 24-week multicomponent intervention programme was implemented in older adults with mild cognitive impairment to promote community activity using community resources.17 The programme included physical, cognitive and social activity. The results demonstrated significant intervention effects on both cognitive and physical functions. These recent initiatives look promising for the promotion of cognitive health. Nevertheless, further research is needed, for example on the long-terms effects.17 18 In addition, there remains a substantial gap in how to turn recommendations into practice for the promotion of individuals’ cognitive health.19

Designing interventions with the aim of promoting health may be a complex challenge for a practitioner or a researcher.20 Wold and Mittelmark21 have argued in favour of expanding health promotion as a transdisciplinary research field. In this regard, social marketing constitutes one potential approach guiding the development of health promotion interventions.22–24 Social marketing aims at (i) identifying marketing principles that can be applied to reach a prosocial goal and (ii) providing a useful theoretical framework for designing interventions and services that will contribute to the development of prosocial behaviours.25 Thus, a social marketing strategy consists of a creation and administration of a marketing plan to effectively attract, motivate and retain an audience in performing a targeted prosocial behaviour. In the field of health, marketing has been defined as a person-centred approach by aligning health (promotion) services with specific characteristics and needs of the targeted populations.26

Social marketing offers strategies27 that may be used to address wider determinants of health and to develop efficient public health interventions. Segmentation is one of those strategies allowing to identify healthcare consumer profiles.28 Tailoring is another important strategy to adapt a service or an intervention to segments of the targeted audience. A recent study showed that tailored communication was more effective in increasing health screening behaviours in primary prevention than non-tailored communication.29 The marketing mix, historically known as the 4Ps—Product, Price, Place and Promotion—can also be helpful. This strategy has been used for example as an approach in public health to categorise the existing nutrition policies, assess their perceived effectiveness and set guidelines for future policy actions.30 With regard to health promotion, a recent systematic review has shown that the use of social marketing strategies was effective in increasing participation in, or the level of physical activity among older adults.31

The Behaviour Change Wheel32 (BCW) is a model created from a review of frameworks for social marketing. Based on this model, it is possible to identify, for the first time, how elderly people perceive their capability, opportunity and motivation to adopt cognitive health promoting behaviours. This market analysis can be obtained from in-depth interviews. Then, a self-reported questionnaire, aligned with the findings from the interviews, will allow to link the capability, opportunity and motivation to the levers of action that should be addressed for each of these components. These levers are categorised as: (i) intervention functions, for example, education, incentivisation, environmental restructuring, modelling or enablement and (ii) policy categories, for example, social planning, service provision, regulation or legislation. Social marketing strategies may concern implementation intentions to increase capability, and ultimately, motivation and participation of older people in behaviour promoting cognitive health. They may also concern the use of public media to increase opportunity for the older people who lack knowledge to get familiar with this domain of their health, and to identify available resources in their local area that will help them maintaining their cognitive health. A last but not least strategy may concern the use of a social identity approach, for example, through positive social norms, to enhance the motivation of older people health-promoting behaviour with regard to their cognitive health. The BCW is one of the ways we can target and segment cognitive health promotion interventions according to the audience’s needs. Social marketing is able to provide the healthcare sector and the government with realistic goals and action strategies in promoting cognitive health among older adults. Efficacy will be measured directly by monitoring the number of people using the services (programmes and interventions) designed to promote cognitive health. A cumulative positive effect can also be observed. If older people use these services more and feel empowered to do so, they will be potentially more motivated and committed to continue using these services, and hence to promote the services among their acquaintances and family.

The potential of social marketing research has not yet been fully developed. We need more evidence to learn how social marketing strategies can be interconnected to further advance the promotion of health in general, and the promotion of cognitive health, in particular. We also need to know how this better understanding can further inform the development and implementation of effective population-based programmes and interventions. Scoping reviews are well-suited for providing a comprehensive overview on a particular topic.33 One of its greatest strengths is to embrace sources of evidence as a whole. Scoping reviews are a multi-method34 approach. They aim to provide an integrative synthesis, which is limited to a given topic.35 They follow a rigorous and replicable scientific method.34 36 Due to the heterogeneity in the sources of evidence included, one main limitation, however, is that scoping reviews do not formally assess quality.36 37 Therefore, scoping reviews might be more useful to assess information prior to a full systematic review rather than to inform practice.38

A preliminary search of PubMed and DoPHER was conducted using the terms “cogniti*” AND “health*” AND “market*”. We found neither scoping nor systematic reviews on this topic. In line with the rationale for conducting scoping reviews, we will map the evidence to explore whether health marketing strategies can inform the efficient implementation and use of services aiming at the promotion of cognitive health. A main goal is to identify in the literature the potential and the gaps concerning this topic. A related goal is to provide the scientific community and policymakers with future research directions. The scoping review will systematically review the literature in three concept groups: (i) social marketing, (ii) health promotion, (iii) cognitive health. The first concept group concerns the identification of social marketing strategies that have been shown to be effective in changing people’s health behaviours or attitudes. In the second concept group we will explore the methods and approaches that have been used to successfully promote healthy lifestyle behaviours in various areas. The third concept group will focus on the methods and approaches that have been used to promote cognitive health.